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A new law that went into effect July 1 says patients no longer need a physician referral before receiving acupuncture treatments.

The upshot for a profession that only became legal in the state within the past 10 years is that acupuncturists should benefit from a boost in business. Competition is expected to increase as well, as the favorable conditions could prompt more of them to seek licenses in Indiana.

The referral requirement has been a thorn in the side of the profession, so to speak, for several years, said Mitchell Harris, president of the Indiana Association of Acupuncture and Oriental Medicine, the locally based trade association that lobbied for the change. He also operates Indy Acupuncture & Health Services Inc. in Broad Ripple with his wife, Erica.

"This law is the beginning of a lot more business," he said, "because a lot more people will be able to experience acupuncture."

Harris and his colleagues had little trouble convincing lawmakers the permission slip had run its course, particularly because their counterparts at the Indiana State Medical Association did not stand in the way.

Dr. Jon Marhenke, president of the ISMA, acknowledged acupuncture has benefits for certain patients and even is aware of a handful of physicians in the state who practice the therapy.

"It's not a pill or treatment used in Western medicine, but it certainly can play a role in chronic pain situations," he said. "It's a real option for people to consider."

The practice of inserting and manipulating fine, filiform needles into specific points on the body originated in China and can be traced as far back as the Stone Age. The aim is to relieve pain, although it's used for other ailments such as allergies, anxiety, sleep disorders and infertility.

While acupuncture has been the subject of scientific research for several years, it remains controversial among researchers and clinicians. A report that appeared in a 2006 issue of the Journal of Internal Medicine found that the "emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions."

Statistics relating to acupuncture remain relatively elusive. But a 2002 survey by the Bethesda, Md.-based National Institutes of Health estimated that 8.2 million Americans have sought acupuncture treatments.

Losing out to chiropractors

The practice of acupuncture has made great strides in Indiana lately, considering its brief history here.

Jennifer Meador-Stone, an owner of East West Acupuncture in Speedway and founder of the IAAOM, began the push to legitimize the profession in the 1990s.

Operating illegally since founding her practice in 1991, she began advertising four years later and promptly received a cease-and-desist order from the State Attorney General's Office. Acupuncture then was considered surgery and punishable by a Class D felony. Meador-Stone never was prosecuted and her business remained open.

Her attorney encouraged her to keep practicing but, in the meantime, educate lawmakers about the benefits of acupuncture. The General Assembly passed a law in 1999 introducing licensing requirements for the industry. The state began granting permits in 2002 to acupuncturists who had graduated from an accredited school and passed a national exam.

Legislators, still leery about granting unabated access to an acupuncturist, included in their licensing legislation the safeguard that patients first must obtain a physician's referral.

Five years later, industry leaders returned to the General Assembly seeking to have the stipulation repealed. A technicality killed the effort last year. This year, the measure was included in a bill containing a broad swath of health-related issues, such as specifying the circumstances in which a nursing home is not required to provide cardiopulmonary resuscitation on a patient who has died.

Acupuncturists sought the change, in part, to even the playing field with chiropractors. Those with at least 200 hours of acupuncture training can treat patients for back pain without a physician referral, which put acupuncturists at a disadvantage, they contended.

Physicians uncomfortable with recommending therapies they know little about and are not covered by many insurers also factored into their argument.

For those reasons, Meador-Stone said, "acupuncturists felt like it was limiting their [number of] patients, and their ability to make money and have good business."

Meador-Stone sees patients two days a week at Bloomington Hospital's Advanced Pain Center. Between there and Speedway, she has built a formidable book of business through word of mouth, which seemingly is the preferred avenue of advertising for the cottage industry. Yet, Meador-Stone expects the patient loads of her peers to increase.

Indy Acupuncture & Health Services on College Avenue prefers to grow its base through recommendations as well, although the change in law will prompt it to advertise in The Broad Ripple Gazette, Harris said.

Whether the ads will result in more business remains unclear, particularly because the profession's niche is so narrow, he said.

"They're either curious or they're trying it as a last resort," Harris said.

It's doubtful that will stop acupuncturists from seeking licenses in Indiana. Meador-Stone is aware of situations in which practitioners opted to locate elsewhere because of the physician referral requirement. But more states are beginning to relax the rules.

In the Midwest, Ohio will follow Indiana and nix its patient referral rule Aug. 22, except for acupuncturists with less than a year of experience. Kentucky requires a referral for certain conditions.

Insurance issues

Next on the IAAOM's agenda could be a push to get mandated insurance coverage for acupuncture. Some insurers provide coverage while others do not. The growth of health savings accounts is helping more patients afford the therapy, Harris said, because acupuncture is a legitimate HSA expense, according to IRS rules.

A typical acupuncture patient might receive four to 12 hour-long treatments costing $65 each. About 70 acupuncturists are practicing in the state, including about 30 that are members of the IAAOM. The Yellow Pages lists 20 acupuncturists in the metropolitan area, including a few chiropractors.

There are 53 accredited acupuncture schools in the country, most of which are on the coasts. The closest to Indianapolis are in Chicago.

Depending upon the state in which they are located, schools offer either three- or four-year programs.

Acupuncture training laws are independently regulated by individual states and may vary. Acupuncturists must pass a national exam to become licensed.

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Real estate, tourism, business of sports

Olson covers real estate, as well as sports and tourism. He joined IBJ in 1999 after spending three years at IBJ’s sister publication, Indiana Lawyer. Olson is an Illinois native and graduate of Western Illinois University—home of the mighty Leathernecks. He spent nearly four years at a small Illinois daily newspaper before joining The Republic in Columbus, Ind., in 1994. There, he covered the courts and cops beat, and he reported news from nearby towns by traipsing through the hinterlands of southeastern Indiana. In his spare time, Olson enjoys reading history books, riding bicycles, running and—most importantly—watching baseball and cheering on the Chicago White Sox. He lives in Zionsville with his wife. They have two college-aged daughters, along with a cat and two spoiled Chihuahuas.

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